In andrology, there are two main problems – impotence (erectile dysfunction) and infertility. Today it is well known that in men with age level of sex hormones, in particular, testosterone, decreases and at the same time there are problems with erection. And this decline begins at the age of 30 – 40 years. In general, level of this hormone is different for different people of even one age, because it is influenced by many factors – lifestyle, concomitant diseases, bad habits, features of genetics and structure of human body.
Concomitant diseases such as diabetes mellitus, arterial hypertension and coronary heart disease lead to decrease in testosterone level by 10 – 15% compared to healthy people of the same age group.
Age-related decrease in level of biologically active testosterone is even greater than decrease in level of total testosterone. Many men after 50 – 60 years have symptoms typical of hypogonadism. These symptoms include:
- disorders of genitourinary system, consisting of decrease in sexual desire, erectile dysfunction, orgasm disorders, decreased sperm fertility, pollakiuria (not related to benign enlargement of prostate);
- symptoms of vegetative disorders include sudden reddening of face, neck, upper body, the so-called “hot flashes”, blood pressure jumps, chest pains, dizziness, air insufficiency;
- disorders of psychoemotional sphere, manifested in increased irritability, rapid fatigue, weakening of memory and attention, insomnia, depressive states, decreased well-being and working capacity;
- body disorders, which are expressed in decreasing muscle mass and strength, reduction of bone tissue density, gynecomastia, appearance or growth of visceral obesity, reduction of number of androgen-dependent hair, thinning and atrophy of skin;
- shifts in laboratory tests, indicating decrease in level of total and biologically active testosterone, increase in hormone level of estradiol and globulin, occurrence of anemia of various degrees, increase in level of lipoproteins with low and very low density.
Treatment of Erectile Dysfunction
It should not be thought that manifestation of symptoms described above is unambiguously associated with level of sex hormones. However, treatment of erectile dysfunction with androgen replacement therapy confirmed its great importance and allowed elimination or reduction of severity of these symptoms.
Canadian Health&Care Mall studies proved relationship of hypogonadism with dyslipoproteinemia, and also the fact that treatment of impotence with drug therapy in hypogonadism gives normalization of fat metabolism in the body. If it is impossible to treat erectile dysfunction with medicines, urologist-andrologist can offer phalloprosthesis. Modern prostheses of penis are not visible, differ with high degree of engraftment and minimum of side effects. Falloprosthesis is the gold standard for treatment of impotence worldwide.
Causes of male infertility are numerous and are due to both genetic abnormalities and impact of environmental factors and lifestyle. Any disease, be it acute or chronic, can lead to violations of spermatogenesis and male infertility. Violations of pituitary, hypothalamus, thyroid or adrenal glands are diagnosed in about 4% of men who underwent infertility studies. In specialized medical institutions hypogonadism due to disruption of endocrine system may be 9%.
Approximately in every 7th infertile man there are defects of sexual chromosomes, lesions of vas deferens, cryptorchidism and other types of testicular insufficiency. In 6% of cases, male infertility was the result of congenital or acquired lesion of testicular epididymis, and 5% were caused by improper technique of coitus, erectile dysfunction, ejaculation disorders or anatomical abnormalities, a significant part of which is attributed to hypospadias. In 6 – 10% of cases, ability to fertilize was disrupted due to autoimmune processes leading to agglutination and poor motility of spermatozoa. Up to 40% of infertile men had varicocele disease, and in 15% male infertility was subclinical. In about 35% of infertile men, cause of infertility is not revealed, it is called idiopathic (unclear) male infertility, challenging modern urology.
The above statistics are only above-water part of iceberg called male infertility, since it is collected on married couples who applied for medical help. These data do not include unmarried men, but more precisely those who do not suspect about their infertility, or simply do not want to be examined and treated.
Fertility (ability of a man to fertilize) is usually successfully restored by treatment of such diseases as:
- hyper- and hypothyroidism;
- adrenal insufficiency;
- hyperglyukocorticism and congenital adrenal hyperplasia.
To identify the exact cause of male infertility, urologist-andrologist will prescribe a number of tests: analysis of spermogram (spermogram for Kruger), ultrasound of scrotum, penis and abdomen, PSA analysis, etc.
Treatment of Male Infertility
If hypogonadotropic hypogonadism is diagnosed, then it is treated with gonadotropins. Inflammatory processes of reproductive system of men are cured by use of appropriate antibiotics and symptomatic anti-inflammatory drugs and procedures. Hopes for success of effects of glucocorticoids on antibodies to spermatozoa did not materialize. There are also no treatments for infertility in men caused by primary hypergonadotropic hypogonadism, ciliary stenosis and chromosomal abnormalities.
Success of treatment depends, in the main, on duration of male infertility. The longer it is, the worse fertility recovery forecast is. Particularly unfavorable is the prognosis of male infertility in diagnosis of severe bilateral epidemitis.
It is understandable that treatment of idiopathic infertility is empirical, and for the most part has unsatisfactory results. A number of Canadian Health and Care Mall studies have shown that use of testosterone in male andropause causes decrease in activity of visceral fat lipase, glucose levels, triglycerides and cholesterol in blood plasma, and also decreases diastolic blood pressure.
If you use testosterone and other hormonal drugs to treat metabolic and hormonal abnormalities, this increases possibility of prostatic adenoma. 8-month testosterone test showed that prostate increased by 12%, but concentration of specific antigen of prostate gland did not change.
It is known that intake of androgens depresses endocrine functions of testicles and spermatogenesis due to negative feedback. In particular, this effect is observed when injecting drugs that have long half-life. It was also noted that in patients with androgen replacement therapy, frequency of apnea syndrome may increase in patients. But it is not excluded that this side effect is characteristic, mainly, for persons who have obesity or chronic lung diseases.
With androgen replacement therapy, complications may occur in the form of fluid retention in the body, physiological enhancement of appetite, and propensity to thrombosis. Thus, side effects and possibility of developing adverse effects of taking testosterone and its derivatives lead to necessity to choose an alternative drug for treatment.